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BRAFV600E testing for low-risk papillary thyroid microcarcinomas -- Computational model from a patient-oriented approach
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  • Idit Tessler,
  • Moshe Leshno ,
  • Gilad Feinmesser,
  • Oded Cohen,
  • Raphael Feinmesser,
  • Eran Alon,
  • Galit Avior
Idit Tessler
Kaplan Medical Center
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Moshe Leshno
Tel Aviv University
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Gilad Feinmesser
Sheba Medical Center
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Oded Cohen
Kaplan Medical Center
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Raphael Feinmesser
Rabin Medical Center
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Eran Alon
Sheba Medical Center
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Galit Avior
Hillel Yaffe Medical Center
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Abstract

Background: Given the good prognosis of low-risk papillary thyroid microcarcinomas (lrPTMCs) accurate risk stratification is valuable to optimize management: active surveillance vs. surgery. BRAFV600E testing was associated with increased recurrence risk, hence AS seems reasonable for mutation-negative lrPTMC. However, when considering AS, patient perception is highly important as adherence and emotional aspects are challenging. In this study, we aimed to model the contribution of BRAFV600E testing for the management of PTMCs when tailored to the patient perspective. Methods: We developed a Markovian model to predict the role of BRAFV600E in prioritizing between hemithyroidectomy (HT) and active surveillance (AS) for lrPTMCs. We used a simulated cohort of lrPTMCs, with probabilities of each strategy driven from previous literature. Outcomes were measured as quality-of-life years (QALYs). One- and two-way sensitivity analyses were conducted to ascertain model robustness. Results: We found that the optimal strategy (e.g., that would maximize QALYs) varies according to BRAFV600E status for patients without a preset predilection between AS to HT. Using one-way sensitivity analysis, we found that the two main variables that have the strongest impact on the decision are the utility of AS and the utility of a disease-free state after HT. Two-way sensitivity analysis demonstrated that BRAFV600E status can define the optimal strategy for patients in the middle zone of the utility range (e.g., patients without clear preference). Conclusions: Our model suggests that BRAFV600E status can facilitate decision-making regarding AS vs. HT for patients without preset predilection. Our model supports further real-life studies of BRAFV600E testing for PTMCs.